It is very important that family and friends know what to do and what to be alert for after someone
they care about has had a suicide attempt. It is a very scary time for both the person and those who care for the person.
I receive a lot of calls from people asking me how to help the person who may have just been released from the hospital or
how to help their teenager cope with a recent attempt by one of their friends. Research shows that in the days, weeks and
months immediately following an attempt is the time when the person needs a lot of support and that is a time that he is most
at risk of suicide. Below please find some helpful links for family and friends. Only 10% of the people who attempt
suicide will go on to complete and die by suicide. But 80% of those who die by suicide have made a previous attempt. So while
chances are that this person won't attempt again, he or she is also at an increased risk for dying by suicide. The first six
months after a hospitalization are especially critical to the suicide attempt survivor, and the person remains at an elevated
risk for the entire first year. Also know that research shows that 90% of those who die by suicide had a diagnosable
mental illness at the time of death. (depression, bipolar disorder, anxiety, substance abuse, eating disorders, yet most people
with a mental illness do not die by suicide).

Try not to focus only on the act itself.
What else was going on in the person's life that may have precipitated the attempt? Do they abuse alcohol or drugs? Do they
gamble? these are some issues that are often associated with attempts. Support is available for these issues.

GO SLOW: Safety and recovery take time. Give them the time they need.

KEEP TO THE PLAN: Check out any changes in the safety and recovery plan with the clinician
before enacting them

TAKE ALL PRESCRIBED MEDICINES: Do not keep unused medication.
Dispose of them safely.

KEEP A SAFE HOUSE: Secure all firearms, prescriptions
medications, car keys, sharp instruments, ropes and poisons. Put up with temporary inconvenience this may bring. Keep the
clinician informed of any changes in situations.

DON'T IGNORE CHANGES: Report
any signs of depression or of an attempt

BE ALERT: Anticipate and monitor behavior
and feelings around stressful events, especially those which involve personal or interpersonal disappointments.

BE LOW KEY: Lower the emotional tone in the house

KNOW HOW
TO GET HELP: Keep emergency numbers public and available

BE AVAILABLE TO LISTEN:
Be ready to be shut out. Keep communications open.

*
If you are a school staff member please go to the bottom of page to see how to support a student returning to school.

After a Suicide Attempt: What Now?

If
you are suffering about the suicide attempt of your loved one, no doubt you’re confused as to the best course of action
to take. What should you expect? What should you do? In fact, this is the most critical time – immediately after an
attempted suicide. But, what, exactly should you do now?

Short-Term Planning

The first
thing to do is to ensure the person is stable. This will most likely require hospitalization, depending on the method
of the attempted suicide and how life-threatening the situation is at the present. The suicidal person cannot be left alone
during the days immediately following the attempt. They are not rational, and, contrary to popular belief that once they’ve
tried to commit suicide and failed, they won’t attempt it again, the truth is that many times they are likely to try
it again at some time in the future.

For
some persons admitted to the hospital following a suicide attempt, the greatest risk is the first few hours after admission.
If possible, stay with the person as long as possible during visiting hours while he or she is in the hospital. If you can’t
be there for the duration, ask others to help spell you. The idea is to monitor what’s going on with your loved one.
This means asking lots of questions of the doctors and nurses, helping to comfort your loved one, and getting help for him
or her if needed.

Suicide prevention experts caution
that the person who has already attempted suicide may try death by suicide while they’re in the hospital. For others,
this risk is greatest when they return home from the hospital.

Again, make sure that the individual is not left alone nor has access to any means of making good on their intention
to do themselves in. This means sweeping the house for any prescription and over-the-counter drugs, poisons, knives and
sharp objects, ropes and cords and, especially, firearms. If your loved one has been living alone, it’s best if you
take him or her into your own home – or move in with them – to ensure their immediate safety.

If medications are prescribed, make sure that the individual takes them
as directed. Many of the medications will help to stabilize mood, especially depression.

Pay attention to your loved one’s diet. Make it a point that he or she takes vitamins and supplements as recommended
by the doctor in order to build up strength that’s probably been depleted. Often times, the suicidal person has neglected
themselves to the extent that they are seriously malnourished.

Let Them Talk

During the time after
the suicide attempt is when you want to engage the person in conversation as much as possible. Let him or her talk –
as long and as often as they wish. In your comments, it’s important not to be judgmental or critical of the person.
That is counter-productive and will discourage any opening up. It’s also very important to show how much you love
the person. He or she is most likely devastated, feeling incredibly lost, ashamed, guilty, fearful of the future, and afraid,
most of all, that you will withdraw your love.

Therapy
Should Be First on the List

Your loved one
needs professional counseling by a licensed and certified therapist. This must be primary on the list of short- and long-term
priorities. In addition to individual counseling, group therapy may be recommended. Make sure the person attends every counseling
session. Don’t allow them to slack off, since therapy takes time to work – and it’s often difficult and
painful for the individual. The tendency is to minimize the risk, saying “I’m okay now. I don’t need any
more therapy.” Don’t buy into this. Push, gently, for continued therapy.

Regular medical checkups are also a good idea. Following the suicide attempt, physical and/or mental
changes occur, and healing takes time. If drugs and alcohol were also part of the individual’s lifestyle, these conditions
need treatment as well.

Make Important Lifestyle Changes

Obviously, things can’t go back to the way they were before.
This often means a severe change of lifestyle, but not always. In any case, some things have to change. Where there was
no counseling, there now has to be. The suicidal person will not “get better” on their own. The reason they
got to the point of despair, enough to want to end their life, won’t just go away. The underlying causes may not even
be known or acknowledged by your loved one. All this has to be dealt with, and the best person to help in the recovery is
a professional therapist.

Through therapy, your loved
one will begin to discover the reasons that led him or her to attempt suicide. Depression, anxiety, fear, shame, disgust
and other emotions will surface that are very powerful and very difficult and painful to deal with. The therapist will suggest
short- and long-term behavioral changes that will help your loved one to better adjust to life.

There is no miraculous pill that will quell suicidal thoughts. There isn’t any set time period during which
the person will be healed. Every person heals on their own timetable. Healing can’t be forced, no matter how much
you or your loved one wants it.

Exercise
plays an important part in rebuilding a healthy physical body. You, and other family members and friends, can help
by encouraging your loved one to engage in sports, running, hiking, swimming, working out, or any strenuous physical activity.
Be sure that this vigorous exercise takes place a minimum of four days a week, and for 30 minutes to an hour each day. Exercise
produces endorphins, the body’s natural feel-good chemicals, which help to reduce feelings of depression.

Be aware that many persons who attempted suicide become withdrawn.
They don’t want to talk. They don’t want any contact with others, including anyone from the outside world. Respect
that feeling, but do encourage your loved one to go out and participate in activities again as he or she is ready to. Make
sure you’re not too pushy on this point, however, as that can be misconstrued and backfire. When they are ready, take
them out to activities and events – but don’t go anywhere that’s too stressful. Your loved one won’t
be ready for that for quite a while.

Be Alert
for Suicide Warning Signs

After the suicide
attempt, it doesn’t mean you’re home free – no matter how much your loved one tells you not to worry. Although
some individuals do not exhibit any warning signs prior to an attempted suicide, about 75 percent do show one or more signs.
You do need to be alert for any of the following warning signs of suicide – as they can occur anytime during the days
and weeks after the initial attempt:

• Depression
or sadness all the time – Note that suicide prevention experts say untreated depression is the number one cause of
suicide. • Talking or writing about death or suicide • Writing a will • Giving away possessions,
especially those the person holds most dear • Dramatic mood changes • Change in eating or sleeping habits • Loss of interest in activities – especially those previously enjoyable • Poor work or school performance • Abuse of drugs or alcohol • Change in personality • Withdrawal from family members and friends • Feelings of hopelessness, being helpless or feeling trapped • Demonstrating strong feelings of anger
or rage • Acting impulsively or recklessly • Feeling excessive shame and/or guilt

If your loved one is in immediate danger, call 911 without delay. Suicide
prevention lifelines are available 24/7 – so make use of them if your loved one needs to talk with someone
urgently. Call 1-800-SUICIDE (1-800-784-2433) or the National Suicide Prevention Lifeline at 1-800-273-TALK
(1-800-273-8255) or in Spanish, 1-888-628-9454.

Things
Not to Do:

Let the person, especially adolescents, be in control of their medication
upon release from the hospital. Dispense the medication(s) yourself.

Ignore it and hope things
just get better.

Tell everyone this is a family business and keep it a shameful secret

Focus all your attention on the suicidal child to the exclusion of the other children.

Hover and monitor every action of the loved one, never allowing him or her a minute to themselves.

Blame, the family member who made the attempt.

Blame yourself.

Think it will never happen again.

Try not to make statements such as "How could
you do this to me?" or "What on earth were you thinking?" or "Whatever made you do it?"

THINGS TO DO:

Remove all guns from the
house and restrict access to lethal means as much as possible

Suggest a session with the therapist
for them and for the family/caretakers before leaving the hospital.

Get individual and family
therapy

Create scales for 3-5 emotions or thoughts such as loneliness, depression, or suicidal
thoughts that can help gauge how he or she is doing and whether or not he or she needs your help.

Family
members need to be supported to deal with their own feelings/reactions. Reach out to trusted friends for help and encourage
the rest of the family to do the same.

Try to make statements such as, "I'm sorry you felt that way and I wish I
could have helped you," or "I'm sorry I didn't realize you were in such pain," or" I can't imagine how
bad you must have felt," or finally, "I want to help you, tell me what I can do to help you now."

Making a Survivor Kit or Box:

Consider
having your loved one make a survival kit or bos, where they can put music, pictures, poetry, anything that will help comfort
them and respresent safety. If the attempt survivor believes it would be helpful, letters and objects to remind them of their
value and the negative impact it would have if they killed themselves can be included. Then, whenever they are upset, they
can go to the box and begin to focus on the moment and not the future.

Hope Cards:

Consider making hope cards, which are simply index cards. The attempt survivor and a supportive person sit down and
write what causes them to feel suicidal on one side of the card and on the other side, they work together to create a list
of things that can challenge or change these thoughts. For example , perhaps someone feels suicidal when they believe nobody
cares for or loves them. On one side they may write, "unloved" and on the other side, they can list all the people
in their life who do care about them and/or love them, such as parents, spouse, siblings, partner, friends, children, etc.
The cards can be carried at all times and when these feelings come up the person can pull them out the stack of cards, read
them and manage his or her feelings.

Resources
and Help:

Keep yourself informed about things
to do for your loved one. Helpful books and literature are readily available from a number of sources. The Feeling Blue Suicide Prevention Council is a non-profit community service organization serving Pennsylvania and the Tri-State Area. Their website contains a lot
of helpful information and links. Here is a link to their booklet, “After an Attempt: The Emotional Impact of a Suicide Attempt on Families.” The booklet covers important Do’s and Don’ts, dealing with a traumatic event, what to say to the attempt
survivor, ways the family can communicate their feelings, how an attempt affects spouses, siblings and parents, and additional
resources.

The U.S. Department of Health and Human Services
(HHS) National Suicide Prevention Lifeline has a downloadable booklet, “After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department.” The booklet covers what happens in the emergency department. First, there’s an assessment. The doctors determine
any psychiatric or medical conditions present, determines if they are or have been treated, and if the suicidal thoughts
or actions are the result of recent change or longstanding behavior. Next, the doctors seek to find out what the person
did to harm themselves, and if there were previous attempts. They also ask if there are any current stressors, and/or anger
in relationships. Doctors need to know what support systems there are, and who is or will be providing treatment, and what
treatment programs are a good match for the individual and the family. The booklet further covers how you can help the emergency
department, next steps after the emergency visit, what you need to know following the emergency department visit –
how to keep your loved one safe, reduce risks, creating a safety plan, self care, moving forward and phone numbers for support
groups.

The National Suicide Prevention Lifeline website has links to various suicide prevention organizations and peer support organizations where you can find more resources
and help. Many of them have online libraries with downloadable publications, booklets and information to help family members
following a suicide attempt by their loved one.

The
Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed organization in the United States focusing
on depression and bipolar disorder. They operate a toll-free referral line 1-800-826-3632 and have a grassroots network
of more than 1,000 patient-run support groups across the country.

The National Alliance for the Mentally Ill (NAMI), a nonprofit, grassroots, self-help, support and advocacy organization of consumers, family and friends of people
with mental illnesses, has information on mental illnesses, programs, support groups, medication and treatment, and more.
There are more than a thousand local affiliates in 50 states.

The Center for Mental Health Services (CMHS), of the Substance Abuse and Mental Health Services Administration (SAMHSA),
maintains a mental health services locator, which you can use to help find services, facilities and resources in your state.

Should You Worry?

It’s natural
to worry that your loved one may try another suicide attempt. But you can’t let this worry define you or derail your
efforts to get professional help for him or her. You may also wish to undergo counseling yourself, to be better able to
deal with the situation and feel better about helping your loved one on his or her journey to healing.

It’s important that you have your own support system in place. You
can’t always be watching over your loved one, fearful that another attempt is imminent. This will just add to your
stress level and make it impossible to maintain a serene environment. Get help around the house – whether that entails
a friend or other family member coming over to be present while you take some needed away time, or while you work, or to
transport your loved one to and from treatment or group meetings, or some other reason.

Remember that one of the most powerful emotions is love. The more you can show how much you love your family member
that you nearly lost to suicide, the better off you both will be. Encourage other family members to be understanding, nonjudgmental
and patient as well. It won’t be easy, and sometimes it may seem next to impossible. But your love and understanding
will go a long way toward helping your loved one on the road to recovery.

**********************************

After
an Attempt: The Emotional Impact of a Suicide Attempt on Families

Where to turn

The best predictor of a future suicide attempt is a previous attempt.
This is why it is important to get help, design a plan of action, and increase communication with your loved one immediately
after an attempt. You may be feeling confused and unsure how to talk to your loved one who attempted suicide.

Feeling Blue SPC has recently published a helpful resource for people who have experienced a suicide attempt
in their family called, After An Attempt: The Emotional Impact of a Suicide Attempt on Families. This booklet includes
information, including:

Students
who have felt so helpless and hopeless to have made a suicide attempt have many challenges to face. The problems that led
to their suicide attempt are still there, and now on top of that they have to deal with having been hospitalized for the attempt.
Peers are not often kind to those who return to school following a psychiatric hospitalization. Although we are trying hard
to reduce the stigma around mental illness, it is still a stigma for many who get admitted into a psychiatric hospital as
opposed to a drug or alcohol rehab.

The school faculty and staff may also not know how to be supportive
to the returning student. Many staff can be insensitive and say thoughtless things that other students may overhear in the
office or hallways. Many staff hold outdated beliefs about mental health treatment which may not lead to the most positive
climate for the student. Still other staff, who are knowledgeable about mental health issues and who themselves may have or
know others in their own life with mental illness, may be the most compassionate.

How school staff
can help: Coming back to school after a traumatic absence is difficult for students, but returning after a suicide attempt
is quiet challenging, especially if everyone knows. Try to give the student as much control as possible over the situation.
Meet with the student before her return to school, plan together what she does and doesn't want you to say and to whom. Practicing
role playing so that she can try out different responses to different situations that may arise will help lower her anxiety.
Teaching her to say, "I don't want to talk about it" gives the student permission to be as private as she would
like to be about the circumstances regarding her absence as needed.

You may want to ask
the student (and parents) for permission to let some of her teachers and some students (that may be in clubs or sports )with
her, to know how she wants to be treated. It is also important that the student's counselor gets consent to read the student's
discharge plan and recommendations as well as to speak with the outside therapist. This helps the student by building a safety
net for her.

The return to school requires individualized attention and regular
follow up. If the attempt isn't public knowledge, not everyone in the school needs to know the details around the student's
absence. Faculty and staff who have direct contact with the student, should be part of her safety net that monitors continuing
risk. Giving instructions to those members of the staff about how they can be most helpful to the student will benefit both
the student and staff. Here are some ideas:

Treat the student's return to school
as you would had the student been out sick for a few days.

Let the student know you are glad
they are back, "Good to see you".

Please respect the student's wishes for the way
in which his absence is discussed. If the attempt is common knowledge, help the student prepare by role-playing comments and
questions from peers or faculty or staff. If no one is really aware, help the student create a short response to explain her
absence. Being prepared helps greatly reduce anxiety and helps the student feel more in control.

Discuss
missed classwork and homework and make arrangements for completion. Adjust expectations for the first days and weeks. Let
her know that she can come to you for help with the work or assign a student to help her catch up. Some teachers will give
a project or a take home assignment for the student to do instead of trying to make up all of the missed homework.

Keep an eye on the student's academic performance as well as her social interactions. If you see that she is isolating
or being shunned by peers or is falling further behind in assignments you can follow up with the students and other teachers
as well.

Pay close attention to further absences, lateness and requests to be excused during
classes. If you are concerned please alert the appropriate staff resource at your school.

Encourage
the student to use the school resources for additional support (school counselor).

Always provide
regular feedback to school resource staff.

Some schools actually have a written
policy for students who return to school following an attempt. Often this requires a meeting at the school with the student,
parents, or caregivers, and selected school staff before the student is allowed to return to school. At this meeting, adjustments
that may be necessary to the student's routine or class schedule may be discussed. Some school will implement a 504 plan if
the student is adjusting to psychotropic medication. This written plan will specify the ways the student's assignments, schedule
and test taking might be adjusted until the student is stabilized and can once again participate fully again in school routines.

A 504 Plan refers to section 504 of the Rehabilitation Act and the American Disabilities Act, which specifies that
no one with a disability can be excluded from participating in federally funded programs or activities, including elementary,
secondary, or postsecondary schooling. "Disability" in this context refers to a "physical or mental impairment
that substantially limits one or more major life activities." A 504 plan spells out the modifications and accommodations
that will be needed for these students to have an opportunity to perform at the same level as thier peers.

Great resource for schools: Lifelines: A Suicide Prevention Program, Lifelines Intevention: Helping
Students At Risk for Suicide and Lifelines Postvention: Responding to a Suicide or Other Traumatic Death. Contact Hazelden
Publications: www.hazelden.org/bookstore